Characterizing neck injuries in the national football league: a descriptive epidemiology study

BACKGROUND: Neck injury is a common and often debilitating injury among athletes participating in American football. Limited data exists regarding neck injuries among elite athletes in the National Football League (NFL). To characterize the epidemiology of non-season ending, season-ending, and career-ending neck injuries in the NFL from 2016 through 2021. METHODS: Athletes who sustained neck injuries were identified using the NFL’s injured reserve (IR) list between the 2016 and 2021 seasons. Demographics and return to sport (RTS) data were collected. Available game footages were reviewed to identify the mechanism of injury (MOI). Injury incidence rates were calculated based on per team play basis. RESULTS: During the 6-year study period, 464 players (mean age 26.8 ± 3.2 years) were placed on the injury reserve list due to neck injuries. There were 285 defensive players and 179 offensive players injured (61.4 vs 38.6%, respectively, p < 0.001). Defensive back was the most common position to sustain a neck injury (111 players, 23.9%). 407 players (87.7%) sustained non-season-ending injuries with a mean RTS at 9.2 ± 11.3 days. 36 players (7.8%) sustained season-ending injuries with a mean RTS at 378.6 ± 162.0 days. 21 players (4.5%) sustained career-ending injuries. The overall incidence of neck injuries was 23.5 per 10,000 team plays. The incidence of season-ending injuries and career-ending injuries were 1.82 and 1.06 per 10,000 team plays, respectively. There were 38 injuries with available footages for MOI assessment (23 non-season-ending, 9 season-ending, 6 career-ending). Head-to-head contact was seen in 15 injuries (39.5%), head-down tackling in 11 injuries (28.9%), direct extremity-to-head contact in 7 injuries (18.4%), and head-to-ground contact in 5 injuries (13.2%). There was no significant difference in age, position, or MOI among players sustaining non-season-ending, season-ending, and career-ending injuries. CONCLUSION: There is a high incidence of neck injuries among NFL athletes with predictable MOIs including head-to-head contact, head-down tackling, direct extremity-to-head contact, and head-to-ground contact. Defensive players were more likely to sustain neck injuries compared to offensive players. Defensive back was the most common position to sustain a neck injury. LEVEL OF EVIDENCE: III.